Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements.

Autor: Bachoumas K; Médecine Intensive Réanimation, District Hospital Center, La Roche-sur-Yon, France., Levrat A; Intensive Care Unit, Regional Hospital Center, Annecy, France., Le Thuaut A; Plateforme de la méthodologie et de la Biostatistique, Direction de la Recherche Clinique, CHU de Nantes, 44093, Nantes Cedex, France., Rouleau S; Intensive Care Unit, Hospital Center, Angoulême, France., Groyer S; Intensive Care Unit, Hospital Center, Montauban, France., Dupont H; Surgical Intensive Care Unit, University Hospital, Amiens, France., Rooze P; Surgical Intensive Care Unit, University Hospital, Nantes, France., Eisenmann N; Intensive Care Unit, Jean Perrin Center, Clermont-Ferrand, France., Trampont T; Intensive Care Unit, University Hospital, Limoges, France., Bohé J; University Hospital, Lyon Sud, Lyon, France., Rieu B; Surgical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France., Chakarian JC; Intensive Care Unit, Regional Hospital Center, Roanne, France., Godard A; Intensive Care Unit, Regional Hospital Center, Saint-Brieuc, France., Frederici L; Intensive Care Unit, Regional Hospital Center, Sud Francilien, Corbeil-Essone, France., Gélinotte S; Intensive Care Unit, Regional Hospital Center, Dieppe, France., Joret A; Surgical Intensive Care Unit, University Hospital, Caen, France., Roques P; Intensive Care Unit, Regional Hospital Center, Cherbourg, France., Painvin B; Intensive Care Unit, Regional Hospital Center, Lorient, France., Leroy C; Intensive Care Unit, Regional Hospital Center, Puy en Velay, France., Benedit M; Intensive Care Unit, Regional Hospital Center, Moulins, France., Dopeux L; Intensive Care Unit, Regional Hospital Center, Vichy, France., Soum E; Intensive Care Unit, Regional Hospital Center, Périgueux, France., Botoc V; Intensive Care Unit, Regional Hospital Center, Saint-Malo, France., Fartoukh M; Intensive Care Unit, University Hospital, Tenon, Paris, France., Hausermann MH; Intensive Care Unit, Regional Hospital Center, Aurillac, France., Kamel T; Intensive Care Unit, Regional Hospital Center, Orléans, France., Morin J; Respiratory Care Unit, University Hospital, Nantes, France., De Varax R; Intensive Care Unit, Regional Hospital Center, Macon, France., Plantefève G; Intensive Care Unit, Regional Hospital Center, Argenteuil, France., Herbland A; Intensive Care Unit, Regional Hospital Center, La Rochelle, France., Jabaudon M; Department of Perioperative Medicine, CHU Clermont-Ferrand and GReD, CNRS, UMR 6293, INSERM U1103, Universite Clermont Auvergne, Clermont-Ferrand, France., Duburcq T; Medical Intensive Care Unit, University Hospital, Lille, France., Simon C; Intensive Care Unit, Regional Hospital Center, Versailles, France., Chabanne R; Neurological Intensive Care Unit, University Hospital, Clermont-Ferrand, France., Schneider F; Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Ganster F; Intensive Care Unit, Regional Hospital Center, Mulhouse, France., Bruel C; Intensive Care Unit, Saint-Joseph Hospital Center, Paris, France., Laggoune AS; Intensive Care Unit, Regional Hospital Center, Guéret, France., Bregeaud D; Intensive Care Unit, Regional Hospital Center, Châteauroux, France., Souweine B; Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France., Reignier J; Médecine Intensive Réanimation, University Hospital, Nantes, France., Lascarrou JB; Médecine Intensive Réanimation, University Hospital, Nantes, France. jeanbaptiste.lascarrou@chu-nantes.fr.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2020 Aug 27; Vol. 10 (1), pp. 116. Date of Electronic Publication: 2020 Aug 27.
DOI: 10.1186/s13613-020-00733-0
Abstrakt: Background: Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV.
Study Design and Methods: This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015.
Results: Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P < 0.0001), flail chest (P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P < 0.001), and noninvasive ventilation (P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7.
Conclusions: EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.
Databáze: MEDLINE
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